BILL NUMBER: AB 930	CHAPTERED  10/10/99

	CHAPTER   717
	FILED WITH SECRETARY OF STATE   OCTOBER 10, 1999
	APPROVED BY GOVERNOR   OCTOBER 6, 1999
	PASSED THE ASSEMBLY   SEPTEMBER 2, 1999
	PASSED THE SENATE   AUGUST 30, 1999
	AMENDED IN SENATE   AUGUST 25, 1999
	AMENDED IN SENATE   AUGUST 18, 1999
	AMENDED IN SENATE   AUGUST 17, 1999
	AMENDED IN SENATE   JUNE 29, 1999
	AMENDED IN ASSEMBLY   MAY 28, 1999
	AMENDED IN ASSEMBLY   MAY 6, 1999
	AMENDED IN ASSEMBLY   APRIL 15, 1999

INTRODUCED BY   Assembly Member Calderon
   (Coauthor:  Assembly Member Cardoza)

                        FEBRUARY 25, 1999

   An act to amend Sections 11875, 11876, 11877.6, 11877.7, 11877.8,
and 11877.14 of, and to add Section 11876.1 to, the Health and Safety
Code, relating to alcohol and drug programs.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 930, Calderon.  Alcohol and drug programs:  narcotic treatment
programs.
   Existing law authorizes the State Department of Alcohol and Drug
Programs to perform certain licensing and inspection duties and to
establish minimum criteria for the operation of methadone and
levoalphacetylmethadol (LAAM) programs for the treatment of narcotic
addicts.
   This bill would require the department to perform these licensing
and inspection duties and to establish and enforce the minimum
criteria for narcotic treatment programs.
   Existing law authorizes the department to conduct annual
inspections of all narcotic treatment programs established and
licensed under these provisions.  Existing law requires the
department, after conducting an inspection, to provide an inspection
report describing any program deficiencies to the licensee, the
program to submit to the department a corrective action plan, and the
department to conduct a subsequent onsite inspection.
   This bill would require the annual inspections of these narcotic
treatment programs to include the evaluation of input regarding
concerns about the narcotic treatment program.  The bill would
require the department to provide an inspection report to the
licensee within 30 days of the completed onsite review, the licensee
to submit a corrective action plan within 30 days of receipt of the
inspection report, the program to implement all corrective actions
contained in the plan within 30 days of approval by the department of
the corrective action plan, and the department to conduct subsequent
inspections of the program.
   This bill would require the department to impose a civil penalty
of $100 a day for a narcotic treatment program that fails to submit a
corrective action plan or to timely implement any corrective action
when it has been found to not be in compliance with applicable laws
and regulations.
   Existing law specifies various other duties of the department with
regard to narcotic treatment programs.
   This bill would revise some of these duties to include studying
and evaluating and providing advice, consultation, and technical
assistance to narcotic treatment programs regarding the programs'
adherence to all applicable laws and regulations and the impact of
the programs on the communities in which they are located.
   Existing law authorizes the director to deny the application for
initial issuance of a license to provide narcotic treatment services
if certain conditions exist with regard to the applicant, or any
partner, officer, director, or 10% or greater shareholder.
   This bill would add to the conditions under which an application
may be denied that the applicant or program violated any of the laws
or regulations governing narcotic treatment programs that relate to
the health and safety of patients, the local community, or the
general public with respect to any other license issued to that
applicant to provide narcotic treatment services.  The bill would
require the department to deny the application for initial licensure
under these conditions unless the department makes certain
determinations regarding the correction of deficiencies in the other
licensed narcotic treatment programs.
   Existing law authorizes the department to suspend or revoke any
license issued under these provisions, or deny an application to
renew a license or modify the terms and conditions of a license upon
certain grounds, including the violation by the licensee of the laws
and regulations governing narcotic treatment programs that relate to
the health and safety of the patients or the general public, or the
repeated violation of the laws and regulations governing narcotic
treatment programs.
   This bill would revise the grounds for these discretionary
departmental actions and would require, rather than authorize, the
department to suspend or revoke a license or deny an application
under these provisions for violations that present an imminent danger
of death or severe harm to any participant of the program or a
member of the general public.
   Existing law authorizes the department to cease review of an
application for a license to provide narcotic treatment services if
certain conditions exist.  Under this provision, the department may
cease review if the applicant was denied a license under the
provisions regulating narcotic treatment programs within the
preceding year.
   This bill would require the department to cease review of an
application for a license under these provisions.  The bill would
also require the department to cease review if the applicant had a
license suspended under these provisions within the preceding year.
   Existing law authorizes the director to issue an order that
prohibits a narcotic treatment program from admitting new patients or
providing patients with take-home dosages of a replacement narcotic
drug when the director makes certain determinations.
   This bill would require the department to issue the order
prohibiting the specified acts.
   Existing law authorizes the department to vacate the order
prohibiting the specified acts when the program submits a corrective
action plan that reasonably addresses the deficiency or substantially
conforms to the required action set out in the order.  Under
existing law, the department order is vacated when the department
accepts a corrective action plan or fails to reject a plan within 10
working days after the receipt of the plan.
   This bill would authorize the department to vacate the order when
the corrective action plan submitted by the program both reasonably
addresses the deficiency and substantially conforms to the required
action set out in the order.  The bill would provide that the
department order is vacated upon acceptance by the department of a
corrective action plan only if the department also ensures
substantial conformity with the required action set out in the order.

   Existing law authorizes the director to issue an order temporarily
suspending a narcotic treatment program license prior to any
administrative hearing under certain circumstances.
   This bill would require the department, when the outcome at a
hearing held subsequent to the temporary suspension is adverse to the
licensee, to suspend a narcotic treatment program's license under
this provision, as provided.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 11875 of the Health and Safety Code is amended
to read:
   11875.  The Legislature finds and declares that it is in the best
interests of the health and welfare of the people of this state to
coordinate narcotic treatment programs to use replacement narcotic
therapy in the treatment of addicted persons whose addiction was
acquired or supported by the use of a narcotic drug or drugs, not in
compliance with a physician and surgeon's legal prescription, and to
establish and enforce minimum requirements for the operation of all
narcotic treatment programs in this state.
  SEC. 2.  Section 11876 of the Health and Safety Code is amended to
read:
   11876.  (a) In addition to the duties authorized by other
provisions, the department shall perform all of the following:
   (1) License the establishment of narcotic treatment programs in
this state to use replacement narcotic therapy in the treatment of
addicted persons whose addiction was acquired or supported by the use
of a narcotic drug or drugs, not in compliance with a physician and
surgeon's legal prescription, except that the Research Advisory Panel
shall have authority to approve methadone or LAAM research programs.
  The department shall establish and enforce the criteria for the
eligibility of patients to be included in the programs, program
operation guidelines, such as dosage levels, recordkeeping and
reporting, urinalysis requirements, take-home doses of methadone,
security against redistribution of the replacement narcotic drugs and
any other regulations that are necessary to protect the safety and
well-being of the patient, the local community, and the public and to
carry out the provisions of this chapter.  A program may admit a
patient to narcotics maintenance or narcotics detoxification
treatment seven days after completion of a prior withdrawal treatment
episode.  The arrest and conviction records and the records of
pending charges against any person seeking admission to a narcotic
treatment program shall be furnished to narcotic treatment program
directors upon written request of the narcotic treatment program
director provided the request is accompanied by a signed release from
the person whose records are being requested.
   (2) Inspect narcotic treatment programs in this state and ensure
that programs are operating in accordance with the law and
promulgated regulations.  The department shall have sole
responsibility for compliance inspections of all programs in each
county.  Annual compliance inspections shall consist of an evaluation
by onsite review of the operations and records of licensed narcotic
treatment programs' compliance with applicable state and federal laws
and regulations and the evaluation of input from local law
enforcement and local governments, regarding concerns about the
narcotic treatment program.  At the conclusion of each inspection
visit, the department shall conduct an exit conference to explain the
cited deficiencies to the program staff and to provide
recommendations to ensure compliance with applicable laws and
regulations.  The department shall provide an inspection report to
the licensee within 30 days of the completed onsite review describing
the program deficiencies.  A corrective action plan shall be
required from the program within 30 days of receipt of the inspection
report.  All corrective actions contained in the plan shall be
implemented within 30 days of receipt of approval by the department
of the corrective action plan submitted by the narcotic treatment
program.  For programs found not to be in compliance, a subsequent
inspection of the program shall be conducted within 30 days after the
receipt of the corrective action plan in order to ensure that
corrective action has been implemented satisfactorily.  Subsequent
inspections of the program shall be conducted to determine and ensure
that the corrective action has been implemented satisfactorily.  For
purposes of this requirement "compliance" shall mean to have not
committed any of the grounds for suspension or revocation of a
license provided for under subdivision (a) of Section 11877.7 or
paragraph (2) of subdivision (b) of Section 11877.7.  Inspection of
narcotic treatment programs shall be based on objective criteria
including, but not limited to, an evaluation of the programs'
adherence to all applicable laws and regulations and input from local
law enforcement and local governments. Nothing in this section shall
preclude counties from monitoring their contract providers for
compliance with contract requirements.
   (3) Charge and collect licensure fees.  In calculating the
licensure fees the department shall include staff salaries and
benefits, related travel costs, and state operational and
administrative costs.  Fees shall be used to offset licensure and
inspection costs not to exceed actual costs.
   (4) Study and evaluate, on an ongoing basis, narcotic treatment
programs including, but not limited to, the adherence of the programs
to all applicable laws and regulations and the impact of the
programs on the communities in which they are located.
   (5) Provide advice, consultation, and technical assistance to
narcotic treatment programs to ensure that the programs comply with
all applicable laws and regulations and to minimize any negative
impact that the programs may have on the communities in which they
are located.
   (6) In its discretion, to approve local agencies or bodies to
assist it in carrying out the provisions of this chapter provided
that the department may not delegate responsibility for inspection or
any other licensure activity without prior and specific statutory
approval.  However, the department shall evaluate recommendations
made by drug program administrators regarding licensing activity in
their respective counties.
   (7) The director may grant exceptions to the regulations adopted
under this chapter if he or she determines that this action would
improve treatment services or achieve greater protection to the
health and safety of patients, the local community, or the general
public.  No exception may be granted if it is contrary to, or less
stringent than, the federal laws and regulations which govern
narcotic treatment programs.
   (b) It is the intent of the Legislature in enacting this section
in order to protect the general public and local communities, that
self-administered dosage shall only be provided when the patient is
clearly adhering to the requirements of the program, and where daily
attendance at a clinic would be incompatible with gainful employment,
education, and responsible homemaking.  The department shall define
"satisfactory adherence" and shall ensure that patients not
satisfactorily adhering to their programs shall not be provided
take-home dosage.
   (c) There is established in the State Treasury a Narcotic
Treatment Program Licensing Trust Fund.  All licensure fees collected
from the providers of narcotic treatment service shall be deposited
in this fund.  Except as otherwise provided in this section, if funds
remain in this fund after appropriation by the Legislature and
allocation for the costs associated with narcotic treatment licensure
actions and inspection of narcotic treatment programs, a percentage
of the excess funds shall be annually rebated to the licensees based
on the percentage their licensing fee is of the total amount of fees
collected by the department.  A reserve equal to 10 percent of the
total licensure fees collected during the preceding fiscal year may
be held in each trust account to reimburse the department if the
actual cost for the licensure and inspection exceed fees collected
during a fiscal year.
   (d) Notwithstanding any provision of this code or regulations to
the contrary, the department shall have sole responsibility and
authority for determining if a state narcotic treatment license shall
be granted and for administratively establishing the maximum
treatment capacity of any license. However, the department shall not
increase the capacity of a program unless it determines that the
licensee is operating in full compliance with applicable laws and
regulations.
  SEC. 3.  Section 11876.1 is added to the Health and Safety Code, to
read:
   11876.1.  The department shall impose a civil penalty of one
hundred dollars ($100) a day for a program that fails to timely
submit a corrective action plan, or to timely implement any
corrective action when it has been found to not be in compliance with
applicable laws and regulations as required in Section 11876.
  SEC. 4.  Section 11877.6 of the Health and Safety Code is amended
to read:
   11877.6.  The director may deny the application for initial
issuance of a license if the applicant, or any partner, officer,
director, or 10 percent or greater shareholder:
   (a) Fails to meet the qualifications for licensure established by
the department pursuant to this article.  However, the director may
waive any established qualification for licensure of a narcotic
treatment program if he or she determines that it is reasonably
necessary in the interests of the public health and welfare.
   (b) Was previously the holder of a license issued under this
article, and the license was revoked and never reissued or was
suspended and not reinstated, or the holder failed to adhere to
applicable laws and regulations regarding narcotic treatment programs
while the license was in effect.
   (c) Misrepresented any material fact in the application.
   (d) Committed any act involving fraud, dishonesty, or deceit, with
the intent to substantially benefit himself or herself or another or
substantially injure another, and the act is substantially related
to the qualification, functions or duties of, or relating to, a
narcotic treatment program license.
   (e) Was convicted of any crime substantially related to the
qualifications, functions, or duties of, or relating to, a narcotic
treatment program license.
   (f) The director, in considering whether to deny licensure under
subdivision (d) or (e), shall determine whether the applicant is
rehabilitated after considering all of the following criteria:
   (1) The nature and severity of the act or crime.
   (2) The time that has elapsed since the commission of the act or
crime.
   (3) The commission by the applicant of other acts or crimes
constituting grounds for denial of the license under this section.
   (4) The extent to which the applicant has complied with terms of
restitution, probation, parole, or any other sanction or order
lawfully imposed against the applicant.
   (5) Other evidence of rehabilitation submitted by the applicant.
   (g) With respect to any other license issued to an applicant to
provide narcotic treatment services, violated any provision of this
article or regulations adopted under this article that relate to the
health and safety of patients, the local community, or the general
public.  Violations include, but are not limited to, violations of
laws and regulations applicable to take-home doses of methadone,
urinalysis requirements, and security against redistribution of
replacement narcotic drugs.  In these cases, the department shall
deny the application for an initial license unless the department
determines that all other licensed narcotic treatment programs
maintained by the applicant have corrected all deficiencies and
maintained compliance for a minimum of six months.
  SEC. 5.  Section 11877.7 of the Health and Safety Code is amended
to read:
   11877.7.  (a) The director shall suspend or revoke any license
issued under the provisions of this article, or deny an application
to renew a license or to modify the terms and conditions of a
license, upon any violation by the licensee of any provision of this
article or regulations adopted under this article that presents an
imminent danger of death or severe harm to any participant of the
program or a member of the general public.
   (b) The director may suspend or revoke any license issued under
this article, or deny an application to renew a license or to modify
the terms and conditions of a license, upon any of the following
grounds and in the manner provided in this article:
   (1) Violation by the licensee of any laws or regulations of the
United States Food and Drug Administration or the United States
Department of Justice, Drug Enforcement Administration which are
applicable to narcotic treatment programs.
   (2) Any violation that relates to the operation or maintenance of
the program that has an immediate relationship to the physical
health, mental health, or safety of the program participants or
general public.
   (3) Aiding, abetting, or permitting the violation of, or any
repeated violation of, any of the provisions set forth in subdivision
(a) or in paragraph (1) or (2).
   (4) Conduct in the operation of a narcotic treatment program which
is inimical to the health, welfare, or safety of either an
individual in, or receiving services from, the program, the local
community, or the people of the State of California.
   (5) The conviction of the licensee, or any partner, officer,
director, or 10 percent or greater shareholder, at any time during
licensure, of a crime substantially related to the qualifications,
functions or duties of, or relating to, a narcotic treatment program
licensee.
   (6) The commission by the licensee, or any partner, officer,
director, or 10 percent or greater shareholder, at any time during
licensure, of any act involving fraud, dishonesty, or deceit, with
the intent to substantially benefit himself or herself or another, or
substantially to injure another and which act is substantially
related to the qualifications, functions or duties of, or relating
to, a narcotic treatment program licensee.
   (7) Diversion of narcotic drugs.  A program's failure to maintain
a narcotic drug reconciliation system that accounts for all incoming
and outgoing narcotic drugs, as required by departmental or federal
regulations, shall create a rebuttable presumption that narcotic
drugs are being diverted.
   (8) Misrepresentation of any material fact in obtaining the
narcotic treatment program license.
   (9) Failure to comply with a department order to cease admitting
patients or to cease providing patients with take-home dosages of
replacement narcotic drugs.
   (10) Failure to pay any civil penalty assessed pursuant to
paragraph (3) of subdivision (a) of Section 11877.14 where the
penalty has become final, unless payment arrangements acceptable to
the department have been made.
   (c) Prior to issuing an order pursuant to this section, the
director shall ensure continuity of patient care by the program's
guarantor or through the transfer of patients to other licensed
programs.  The director may issue any needed license or amend any
other license in an effort to ensure that patient care is not
impacted adversely by an order issued pursuant to this section.
  SEC. 6.  Section 11877.8 of the Health and Safety Code is amended
to read:
   11877.8.  (a) The department shall cease review of an application
for a license if:
   (1) An application for a license indicates, or the department
determines during the application inspection process, that the
applicant was issued a license under this article and the prior
license was revoked within the preceding two years.  The department
shall cease any further review of the application until two years
have elapsed from the date of the revocation.
   (2) An application for a license indicates, or the department
determines during the application inspection process, that the
applicant was denied a license or had a license suspended under this
article within the preceding year.  The department shall cease any
further review of the application until one year has elapsed from the
date of the denial or suspension.
   (b) The department may cease review of an application for license
renewal if either of the following occur:
   (1) The applicant has not paid the required license fee.
   (2) The county in which the licensee is located certifies to the
department's satisfaction that there is no need for the narcotic
treatment program because of a substantial decline in medically
qualified narcotic treatment patients in the licensee's catchment
area, or clearly demonstrates that other applicants for licensure can
provide more efficient, cost-effective and sufficient narcotic
treatment services in the catchment area, or that the license should
not be renewed due to one of the grounds which are enumerated in
Section 11877.7.
   (c) Upon cessation of review, the license shall be permitted to
expire by its own terms.  However, if the licensee subsequently
submits the items, the absence of which led to the cessation of
review, the department may reinstate the license.
   (d) Cessation of review shall not constitute a denial of the
application for purposes of Sections 11877.6 and 11877.7.
  SEC. 7.  Section 11877.14 of the Health and Safety Code is amended
to read:
   11877.14.  (a) (1) The director shall, in addition to any other
remedy, issue an order that prohibits a narcotic treatment program
from admitting new patients or from providing patients with take-home
dosages of a replacement narcotic drug when the director determines
pursuant to the compliance inspection procedures set out in paragraph
(2) of subdivision (a) of Section 11876, that a program has done any
of the following:
   (A) Failed to provide adequate security measures over its narcotic
drug supply as agreed in the program's approved protocol.
   (B) Failed to maintain a narcotic drug reconciliation system which
accounts for all incoming and outgoing narcotic drugs.
   (C) Diverted narcotic drugs.
   (D) Repeatedly violated one or more departmental or federal
regulations governing narcotic treatment programs, which violations
may subject, or may have subjected a patient to a health or
life-endangering situation.
   (E) Repeatedly violated one or more departmental or federal
regulations governing the provisions of take-home medication.
   (F) Operated above combined licensed capacity for maintenance and
detoxification programs at a single location.  This paragraph shall
not become operative until department regulations on narcotic
treatment programs are revised to identify specific requirements in
conjunction with this paragraph.
   (2) (A) The order becomes effective when the department serves the
program with a copy of the order.  The order shall state the
deficiencies forming the basis for the order and shall state the
corrective action required for the department to vacate the order.
The order, as it pertains to subparagraph (F) only, shall
automatically be vacated when the department receives the program's
written notification that licensed capacity has been achieved.  If
the order is issued pursuant to subparagraph (A), (B), (C), (D), or
(E), the department shall vacate the order when the program submits a
corrective action plan that reasonably addresses the deficiency or
substantially conforms to the required action set out in the order.
   (B) The department shall notify the program that the corrective
action is accepted or rejected within 10 working days after receipt
of the plan.  If the department rejects the corrective action plan,
it shall detail its reason in writing.  The department order is
vacated when the department either accepts a corrective action plan
and ensures substantial conformity with the required action set out
in the order or fails to reject a plan within 10 working days after
receipt of the plan.
   (3) In addition to any other remedies, a failure of the program to
comply with the order of the department under this subdivision shall
give rise to a civil penalty of five hundred dollars ($500) a day
for each day that the order is violated.
   (4) All civil penalties collected by the department under
paragraph (3) shall be deposited in the Narcotic Treatment Program
Licensing Trust Fund, and shall be used to offset the department's
costs associated with collecting the civil penalties, or associated
with any civil, administrative, or criminal action against the
program when appropriated for this purpose.
   (b) (1) The director may, in addition to any other remedy, issue
an order temporarily suspending a narcotic treatment program license
prior to any administrative hearing for the reasons stated in
subparagraphs (A) to (E), inclusive, of paragraph (1) of subdivision
(a) when the department determines pursuant to the compliance
inspection procedures set out in paragraph (2) of subdivision (a) of
Section 11876, that the action is necessary to protect patients of
the program from any substantial threat to their health or safety, or
to protect the health or safety of the local community or the people
of the State of California.  Prior to issuing the order the director
shall assure continuity of patient care by the program's guarantor
or through the transfer of patients to other licensed programs.  The
director may issue any needed license or amend any other license in
his or her effort to assure that patient care is not impacted
adversely by the suspension order.
   (2) The director shall notify the licensee of the temporary
suspension and the effective date thereof and at the same time shall
serve the licensee with an accusation.  Upon receipt of a notice of
defense to the accusation by the licensee, the director shall, within
15 days, set the matter for hearing, and the hearing shall be held
as soon as possible, but not later than 20 days, exclusive of
weekends, after receipt of the notice.  The temporary suspension
shall remain in effect until the hearing is completed and the
director has made a final determination on the merits.  However, the
temporary suspension shall be deemed vacated if the director fails to
make a final determination on the merits within 20 days after the
original hearing has been completed.  Failure to cease operating
after the department issues an order temporarily suspending the
license shall constitute an additional ground for license revocation
and shall constitute a violation of Section 11877.6.  The department
shall suspend the program's license if the hearing outcome is adverse
to the license.  The department shall notify the program of the
license suspension within five days of the director's final decision.

   (3) Failure of the licensee to cease operating after the director
issues a temporary suspension order under paragraph (1) shall
constitute an additional ground for license revocation.
   (c) A program may, at any time after it is served with an order,
petition the superior court to review the department's issuance of an
order or rejection of a corrective action plan.
